New Caution, and Some Reassurance, on Vasectomy

By LAWRENCE K. ALTMAN

Published: February 21, 1993

TWO studies reported last week in the Journal of the American Medical Association linked vasectomy and prostate cancer, focusing attention on a procedure that is one of the most effective methods of contraception and probably the most common operation in adult American men.

More than 15 percent of men over the age of 40 have had a vasectomy. In assessing the procedure, Population Reports, which is published by Johns Hopkins University in Baltimore, has said:

"For the man who wants no more children, vasectomy offers much: effectiveness, a quick and simple procedure, permanent protection, convenience, little risk of complications, no long-term effect on his own health or sexual performance, and no health risks for his wife."

An editorial accompanying last week's studies said that men seeking a vasectomy should be advised of the findings, but cautioned against an over-reaction to the possible health hazard. Men who already had vasectomies, it said, need not try to have them reversed, because the conclusions were preliminary. About one in 11 American men get prostate cancer; the unanswered question is whether vasectomy increases the risk of the disease and, if so, by how much. So the editorial suggested that men who have had the procedure get an annual checkup, as recommended by the American Urological Association and the American Cancer Society.

"There is ample evidence that vasectomy is remarkably safe," said Dr. Herbert B. Peterson, a co-author of the editorial and an epidemiologist at the Centers for Disease Control and Prevention, a Federal agency in Atlanta. The procedure, he added, is even safer and more effective than its female counterpart, tubal ligation. Women face a slightly greater risk in undergoing a tubal ligation because of the use of general anesthesia. And the cost rises if a hospital stay is needed.

In assessing benefits and risks of a procedure, epidemiologists look for consistency among studies. A main reason for caution about the vasectomy-prostate cancer link is that two similar earlier studies had failed to find evidence for one.

Vasectomy provides permanent sterilization by sealing off the two tubes that carry sperm from the testes to the urethra. The procedure takes less than half an hour to perform, does not affect sexual performance, but is not immediately effective when the patient leaves the doctor's office. Men must get rid of stored sperm -- as measured by two tests that fail to detect sperm -- before they or their partners can safely discontinue other forms of birth control.

Vasectomies can be reversed through tedious, costly microsurgical techniques that take much longer than the original procedure. But even when the tubes can be reconnected, there is only about a 50 percent chance that the patient will become a new father. Thus men are warned to regard a vasectomy as permanent.

The typical American man who chooses a vasectomy is most likely to be white, well educated and affluent, in his mid-to-late thirties, have at least one son, live in the West and strongly dislike other contraceptive methods, the Association for Voluntary Surgical Contraception in New York City says. And the man is likely to ponder the procedure for two to 10 years before actually having it.

Throughout the world, more women than men choose surgical sterilization. In the United States, current estimates are that 500,000 vasectomies and 650,000 tubal ligations are performed each year.

Although vasectomy is hardly used in most countries, at least 42 million couples around the world rely on it for family planning. It is a major family planning method in only six developed countries (Australia, Britain, Canada, Netherlands, New Zealand and the United States), and in three developing countries (China, India and South Korea). More than 10 million vasectomies have been performed in China.

Yet vasectomies can be performed in virtually all countries and at low cost, the World Health Organization, a United Nations agency in Geneva, says.

The procedure was developed about 100 years ago, to address noncontraceptive concerns like curing urinary and prostate disease, treating impotence or, alternatively, lowering sex drive. But research has shown that it does nothing for those problems.

In the United States, vasectomy's popularity as a true contraceptive grew in the 1960's and 1970s, as tubal ligation was also becoming popular. The number of vasectomies performed dropped in the late 1970's and early 1980's, after researchers from Oregon reported an increased risk of atherosclerosis in animals following vasectomy. But when further studies provided evidence that it did nothing to increase the risk of heart disease, it became popular again.

Since 1986, at least 500 doctors have taken training courses in the United States to learn how to do a vasectomy without a scalpel. The technique was developed in China and relies on a puncture to seal the tubes. Proponents say it leaves an even smaller scar and results in fewer complications, like bleeding.